Dáil Éireann Debate, Tuesday - 7 March 2017
630. Deputy Louise O'Reilly asked the Minister for Health if his attention has been drawn to the intense struggle endured by many persons suffering from chronic Lyme disease; his plans to support the affected persons adequately; and if he will make a statement on the matter. [12021/17]
View answerLyme disease (also known as Lyme borreliosis or LB) is an infection caused by a spiral-shaped bacterium called Borrelia burgdorferi that is transmitted to humans by bites from ticks infected with the bacteria. The infection is generally mild affecting only the skin, but can occasionally be more severe. Lyme disease is the commonest cause of tick-borne infection in Europe.
Lyme borreliosis can be asymptomatic or have a range of clinical presentations. Current best advice is that diagnosis should be made only after careful examination of the patient's clinical history, physical findings, laboratory evidence and exposure risk evaluation. Exposure to ticks prior to disease manifestations is necessary for the diagnosis of Lyme borreliosis. Since an awareness or recollection of a tick-bite is not always present, however, this should not exclude the diagnosis of Lyme borreliosis. Later stages require the use of antibody detection tests (or advanced DNA detection techniques). Testing for Lyme Disease is undertaken in most of the larger hospitals in Ireland. In undertaking Lyme testing, it is essential that the results are interpreted in the light of the clinical condition of the patient. If the result of this initial screen is equivocal, the patient's samples are referred to the U.K.'s Public Health England Porton Down facility which uses a two-tier system recommended by American and European authorities. This involves a screening serological test followed by a confirmatory serological test.
Lyme disease can be very successfully treated using common antibiotics. These antibiotics are effective at clearing the rash and helping to prevent the development of complications. Antibiotics are generally given for up to three weeks. If complications develop, intravenous antibiotics may be considered. In Ireland, treatment by most clinicians is based on that laid out in evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis published by the Infectious Diseases Society of America (IDSA) in 2006.
This pharmacological regime can be summarised thus:
- Doxycycline, amoxicillin or cefuroxime for the treatment of adults with early localized or early disseminated Lyme disease associated with erythema migrans, in the absence of specific neurologic manifestations (ceftriaxone in early Lyme disease for adults with acute neurologic disease manifested by meningitis or radiculopathy);
- Doxycycline, amoxicillin, or cefuroxime for adults with Lyme arthritis but without clinical evidence of neurologic disease;
- For late neurological disease in adults - intravenous ceftriaxone, cefotaxime or Penicillin G.
Since 2013, the HPSC has held an annual ‘Lyme Awareness Week’ at the beginning of the tick biting season, the purpose of which is to draw attention - particularly in the media - to Lyme disease and the ticks that can spread this disease. Lyme cases tend to appear in Ireland with greater frequency after April, hence the choice of this time of year for Lyme Awareness Week. Both the Health Protection Surveillance Centre and Tick Talk Ireland provide guidance on protection against contracting Lyme borreliosis. The best protection is to prevent tick bites, when walking in grassy, bushy or woodland areas, particularly between May and October. Further advice can be obtained from the HPSC website (www.hpsc.ie) and the HPSC produced a leaflet on “Protecting Yourself Against Tick Bites and Lyme Disease” which is available for the public to download.
My colleague, Minister of State Corcoran Kennedy, who has responsibility for health protection, met with representatives from Tick Talk last summer, and listened to their experiences and the impact of this condition. Their stories showed the need for additional awareness of Lyme disease, both by the public and the health services.
A Lyme Borreliosis Sub-Committee of the Scientific Advisory Committee of the HPSC has been established to look at methods of raising awareness especially in those areas (including recreation areas) where Lyme-carrying ticks can be most expected to be found. The aim of this Sub-Committee is to develop strategies to undertake primary prevention in order to minimise the harm caused by Lyme Borreliosis in Ireland. In addition to staff from the HPSC, the membership of the Sub-Committee includes specialists in Public Health Medicine, Consultants in Infectious Diseases, Clinical Microbiology, Occupational Health an Entomologist from the Parks and Wildlife Service, a representative from the Local Government Management Agency, an Environmental Health Officer, and member of Tick Talk has been invited to be the patient representative on the Sub-Committee. The initial involves a survey of laboratory methods for the diagnosis of Lyme borreliosis in Ireland, the development of Lyme borreliosis guidance for general practitioners, the publication of medical media articles to highlight diagnostics and laboratory methods relating to Lyme borreliosis available in Ireland for general practitioners, and ongoing work in drawing together the Final Report of the Sub-Committee.
